Dear Partner,

The CDT2013 has introduced a new dental code to the Dental Medicaid Fee Schedule.  The new code for the topical application of fluoride, regardless of the form of fluoride used, will be D1208.  The codes D1203, D1204 and D1206 will no longer be reimbursed through the State Dental Medicaid Program for dates of service after December 31, 2012. Effective with dates of service beginning on January 1, 2013, please submit all fluoride treatments for adults or children using D1208. The reimbursement rates for D1208 are as follows:

Adults              Children (<21)

D1208           $ 15.08           $ 29.00

D1208 has a frequency limit of one service every six months. Prior authorization is required for more frequent fluoride applications or for clients over the age of twenty one. 

If you have any questions please contact the Connecticut Dental Health Partnership at 1-855-CT-DENTAL (1-855-283-3682).

Sincerely,

The Connecticut Dental Health Partnership